Emergency Care for Children Growing Pains (2007) / Chapter Skim
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4 Arming the Emergency Care Workforce with Pediatric Knowledge and Skills
4 Arming the Emergency Care Workforce with Pediatric Knowledge and Skills
Pages 151-186
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From page 151... ...
This is a long-standing problem that has improved somewhat over time, but naturally has led to continued concerns about the ability of the emergency care workforce to care properly for pediatric patients. To reduce the consequences of illness and injury, the workforce must have the knowledge and skills necessary to deliver appropriate pediatric emergency care.
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From page 152... ...
. EMT-Bs are those trained to provide basic, noninvasive prehospital care, although their scope of practice varies by state and may include certain invasive procedures in some states.
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From page 153... ...
The EMT profession is different from most medical occupations in that a substantial number of workers serve in a volunteer capacity. According to data gathered from a sample of members of the National Registry of Emergency Medicine Technicians (NREMT)
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From page 154... ...
Rural EMS agencies face particular volunteer staffing shortages during the weekday work hours. Pediatric Training Although there are National Standard Curricula for all levels of EMT training, those curricula are not mandatory, so training requirements for certification vary across states.
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From page 155... ...
It is an intensive 16- to 20-hour course attended by all levels of EMTs. In 1992, the first national consensus curriculum on prehospital pediatrics was published by the California Pediatric Emergency and Critical Care Coalition, the California Emergency Medical Services for Children (EMS-C)
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From page 156... ...
The course is overseen primarily by EMTs, with strong guidance from a pediatric emergency medicine physician.
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From page 157... ...
A survey of EMS agencies in North Carolina revealed that only 11 percent of agencies provided more than 10 hours of basic training in pediatric emergency care (Zaritsky et al., 1994)
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From page 158... ...
. Quality of Care Lack of initial and continuing pediatric education, coupled with the low frequency with which EMTs encounter critical pediatric patients, results in a lower level of care than should be expected of the nation's prehospital emergency care system.
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From page 159... ...
. Comfort in Caring for Pediatric Patients Studies indicate that many EMTs are less comfortable caring for pediatric patients, particularly infants, than for adult patients.
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From page 160... ...
A medical specialty of emergency medicine (EM) was created to enhance
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From page 161... ...
and ABEM. Pediatric emergency medicine is now a recognized subspecialty of the American Board of Medical Specialties.
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From page 162... ...
Approximately 23 percent of EDs have a pediatric emergency medicine physician attending. Children's hospitals and hospitals with large volumes of pediatric patients (more than 7,500 pediatric ED visits per year)
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From page 163... ...
In the early 1980s, there was considerable concern about the level and quality of pediatric emergency care training provided in these programs. Pediatric emergency care training accounted for approximately 16 percent of training time for EM residents, even though pediatric patients represented about 25 percent of all ED visits (Ludwig et al., 1982)
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From page 164... ...
. An assessment conducted in the late 1990s found that the supply of EM physicians was simply not sufficient to staff all ED physician positions, and not all EDs had access to a pediatric emergency medicine physician on staff (Holliman et al., 1997)
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From page 165... ...
Pediatric and Trauma Surgeons The other medical specialties of particular relevance to pediatric emergency care are the surgical subspecialties of trauma surgery and pediatric surgery. In a 5-year residency training program in general surgery, surgeons receive training in a number of specialty areas, including trauma and pediatric surgery, after which they are expected to be able to manage the commonly encountered and less complex cases associated with these content areas (The American Board of Surgery, 2004)
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From page 166... ...
or residency training in the specialty area followed by specialized pediatric training (e.g., pediatric surgery, orthopedics, or plastic surgery)
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From page 167... ...
Pediatric emergency cases are especially risky because the patient is often seriously ill or injured; medical records may be scant or nonexistent; treatment may be rendered after hours, when resources for care are less readily available; and the doctor lacks an established relationship with the child and his or her family. The rapidly rising cost of malpractice insurance is a powerful disincentive for specialists to assume liability by treating unknown emergency patients, many of whom are uninsured, may be noncompliant with discharge instructions, and may be difficult to contact regarding follow-up (Green et al., 2005)
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From page 168... ...
Nurses There are between 75,000 and 100,000 nurses working in EDs. According to the Emergency Nurses Association (ENA)
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From page 169... ...
Many nursing management positions require advanced degrees. Some ED nurses specialize in caring for children and may work in pediatric EDs, but there is no certification available in pediatric emergency nursing, and very little data exist regarding these nurses.
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From page 170... ...
PAs must be granted clinical privileges at the hospital in which they work and can prescribe medication in most states. There are three PA educational programs in the United States offering specializations in emergency medicine, although PAs do not need to graduate from such a program to practice in EDs.
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From page 171... ...
2005 National Patient Safety Goals and Requirements, which call for complete and accurate medication reconciliation across the continuum of care (JCAHO, 2005)
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From page 172... ...
The limited information available on physician performance tends to focus on intubation of pediatric patients in the ED. Some findings indicate that EM and pediatric emergency medicine fellows are generally successful in performing pharmacologically assisted intubation, an airway intervention that is frequently used in the ED (Tayal et al., 1999; Sagarin et al., 2002)
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From page 173... ...
. Additionally, a study of pediatric patient encounters during EM residents' pediatric emergency medicine rotation found deficiencies in critical care procedures, resuscitations, child abuse evaluations, and neonatal evaluations (Chen et al., 2004)
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From page 174... ...
Many nurses working in EDs, particularly in rural settings, have not sought CEN certification and have not taken the emergency nursing pediatric course. To ensure that these professionals receive proper pediatric emergency medicine education, JCAHO and state licensing bodies should evaluate ED staff's pediatric training for certification; similarly, pediatricians working in the ED should be assessed on their EM training.
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From page 175... ...
Developing Clinical Practice Guidelines for Pediatric Emergency Care Treatment patterns for pediatric patients can vary widely among providers. In some cases, this variation is due to providers' lack of education.
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From page 176... ...
. In 2002, the EMS-C program initiated the Clinical Practice Guidelines for Pediatric Emergency Care demonstration project, which provided funding for two projects to help develop practice guidelines.
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From page 177... ...
The more organizations are involved in the development, the more likely it will be that the guidelines will be used in practice in various disciplines. Unless there is a commitment to funding pediatric emergency medicine research, however, there will not be an adequate evidence base from which to derive practice guidelines.
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From page 178... ...
The guidelines stipulate that the physician coordinator may be a staff physician with other responsibilities in the ED, but should meet the criteria for credentialing as a specialist in emergency care, pediatric emergency medicine, or pediatrics and have a special interest, knowledge, and skill in emergency medical care of children. The guidelines stipulate further that the nurse coordinator should have an interest, knowledge, and skill in emergency care and resuscitation of infants and children as demonstrated by training, clinical experience, or focused continuing nursing education.
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From page 179... ...
4.3 Emergency medical services agencies should appoint a pedi atric emergency coordinator, and hospitals should appoint two pediatric emergency coordinators -- one a physician -- to provide pediatric leadership for the organization. REFERENCES AAP (American Academy of Pediatrics)
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From page 180... ...
2004. Program Require ments for Residency Education in Pediatric Emergency Medicine.
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From page 181... ...
2004. Emergency medicine resident rotation in pediatric emergency medicine: What kind of experience are we providing?
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2001. Comparative practice patterns of emergency medicine physicians and pediatric emergency medicine physicians managing fever in young children.
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From page 183... ...
emergency depart ments 1992 to 2000: Epidemiology and practice variation. Pediatric Emergency Care 21(4)
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From page 184... ...
1997. Assessment of the Current Status of Continuing Education Training in Pediatric Emergency Care in Emergency Medicine.
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From page 185... ...
2000. Pediatric emergency medicine education in emergency medicine training programs.
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